Overview
What is it?
Oral tetracycline is a type of antibiotic that belongs to the tetracycline class of drugs. It is naturally occurring and has been used since the 1940s to treat various bacterial infections, including acne. Tetracyclines work by inhibiting bacterial protein synthesis, making them effective against acne-causing bacteria.
How does it work?
Oral tetracycline combats acne by reducing the population of *Cutibacterium acnes* (formerly *Propionibacterium acnes*), the bacteria responsible for acne inflammation. It also has anti-inflammatory properties, which help reduce redness and swelling associated with acne lesions. By targeting both bacteria and inflammation, oral tetracycline helps clear existing acne and prevent new breakouts.
What are the benefits?
Oral tetracycline is particularly effective for moderate-to-severe acne. It can significantly reduce the number of inflammatory lesions (like pimples and cysts) and improve overall skin appearance. When combined with topical treatments like retinoids and benzoyl peroxide, it has been shown to reduce total lesion counts by up to 43% compared to placebo .
Effectiveness
What does the research say?
Research shows that oral tetracycline is a well-established treatment for acne, especially when used in combination with other therapies. Studies indicate that combining oral tetracycline with topical retinoids and benzoyl peroxide is more effective than using these treatments alone. For example, one study found a 43% reduction in total lesion counts with this combination . Oral tetracycline is particularly recommended for cases where topical treatments alone are insufficient.
Side Effects
Tooth discoloration
Tetracyclines can cause permanent tooth discoloration, especially in children under 8 years old or when used during pregnancy. This occurs because tetracyclines bind to calcium in developing teeth, leading to yellow, gray, or brown staining .
Gastrointestinal discomfort
Common gastrointestinal side effects include nausea, vomiting, and diarrhea. These symptoms are usually mild but can be bothersome for some patients .
Photosensitivity
Tetracyclines can make the skin more sensitive to sunlight, increasing the risk of sunburn. Patients are advised to use sunscreen and avoid prolonged sun exposure while taking this medication .
Risk of intracranial hypertension
In rare cases, oral tetracyclines have been associated with idiopathic intracranial hypertension (IIH), a condition characterized by increased pressure in the skull. Symptoms include severe headaches, vision changes, and nausea. This side effect is more common in women of childbearing age .
Potential liver enzyme elevation
Some patients may experience elevated liver enzymes during treatment, though clinically apparent liver injury is rare. Regular monitoring may be recommended for long-term use .
Evidence
Clinical Studies & Trials
[1] Guidelines of care for the management of acne vulgaris.
This guideline provides evidence-based recommendations for managing acne vulgaris, including the use of oral tetracyclines.
View study[2] Guidelines of care for the management of acne vulgaris.
This guideline reviews the management of acne, including the use of oral antibiotics like tetracyclines.
View study[3] A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris.
This meta-analysis evaluates the effectiveness of combined treatments, including oral tetracyclines, for moderate-to-severe acne.
View study[4] Sarecycline
This review discusses sarecycline, a narrow-spectrum tetracycline derivative used for acne, and its potential side effects, including liver enzyme elevation.
View study[5] Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity.
This review explores the side effects of tetracyclines, including tooth discoloration and oral cavity staining.
View study[6] Drug-Induced Intracranial Hypertension: A Systematic Review and Critical Assessment of Drug-Induced Causes.
This systematic review examines the link between tetracyclines and idiopathic intracranial hypertension.
View study[7] Rosacea in children: a review.
This review discusses the use of oral tetracyclines in pediatric rosacea and their potential side effects, including tooth discoloration.
View study[8] Acne aestivalis.
This case report describes a rare form of acne and its treatment, including the use of retinoids.
View study[9] Acne vulgaris.
This review discusses the use of topical and oral treatments for acne, including tetracyclines.
View study[10] Azelaic acid. A review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders.
This review compares the efficacy of azelaic acid with other acne treatments, including oral tetracyclines.
View study